Journal of vascular surgery. Venous and lymphatic disorders最新文献

{"title":"Advancing opportunity and representation in the American Venous Forum","authors":"Lucy Yang MD ,&nbsp;Ruth L. Bush MD, JD, MPH ,&nbsp;Kathleen Ozsvath MD ,&nbsp;Misty D. Humphries MD ,&nbsp;Karem Harth MD, MHS","doi":"10.1016/j.jvsv.2025.102239","DOIUrl":"10.1016/j.jvsv.2025.102239","url":null,"abstract":"<div><h3>Objective</h3><div>Diversity, equity, and inclusion (DEI) within the physician workforce is critical to establishing a diverse provider network that accurately represents the patient population served by vascular surgeons. Vascular surgery remains a largely male-dominated surgical specialty, and the number of women in leadership positions in academic surgical specialties continues to be disproportionate. The representation of women in leadership roles differs across vascular surgery societies. The goal of this study is to provide an update on the representation of women and incorporation of DEI topics at American Venous Forum (AVF) annual meetings and across committees.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of available scientific meeting programs and abstracts presented at the AVF from 2010 to 2023. The time period was divided into before 2019 and after 2019, as this was the year that the Society for Vascular Surgery established the Task Force on DEI. Women’s participation and DEI domains were documented for each year. A two-sample unpaired <em>t</em>-test was used to compare mean percentages.</div></div><div><h3>Results</h3><div>Specifically, within the AVF, women’s representation across all roles (presenters, senior authors, moderators, committee chairs, committee members, and officers) has increased when comparing prior years (2010-2019) with a more recent time period (2020-2023). The largest increase was observed for moderators (12.6% vs 30.2%; +17.6%), and the smallest increase was observed for presenters (21.1% vs 28.9%; +7.8%). When comparing the same time periods, the mean percentage of DEI domains (access to care, race and ethnicity, gender, age, health literacy, and socioeconomic status) highlighted in research presentations at AVF annual meetings has increased numerically over time but is not statistically significant except for the DEI domain of age (1.34% vs 3.28%; <em>P</em> = .0008).</div></div><div><h3>Conclusions</h3><div>Although there have been positive improvements in the proportion of women in leadership roles at the AVF, the integration of DEI domains at AVF annual meetings continues to show slow progress. This study reflects an opportunity for AVF leaders and councils to prioritize strategies to incorporate important DEI domains into our annual meetings and mission-related efforts. Intentional progress in these areas will ultimately contribute to more successfully carrying out the AVF Core Values (VEINS: <strong>V</strong>alues and integrity, <strong>E</strong>ducation, <strong>I</strong>nclusivity, equity, diversity, <strong>N</strong>urturing, <strong>S</strong>cientific excellence and research).</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102239"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of ultrasound-guided microwave ablation for vascular malformations in children","authors":"Shuting Huang MD ,&nbsp;Fenglin Xu MD ,&nbsp;Xin Li MD ,&nbsp;Hongxia Zhang MD ,&nbsp;Jingyu Chen MD, PhD ,&nbsp;Zhenzhen Zhao MD, PhD ,&nbsp;Jun Zhang MD, PhD ,&nbsp;Liang Peng BS ,&nbsp;Xiangru Kong MD","doi":"10.1016/j.jvsv.2025.102240","DOIUrl":"10.1016/j.jvsv.2025.102240","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to report our center’s experience in treating pediatric vascular malformations using ultrasound-guided microwave ablation.</div></div><div><h3>Methods</h3><div>Twenty-two symptomatic children with vascular malformations underwent ultrasound-guided microwave ablation. All patients received ultrasound follow-up after microwave ablation, whereas magnetic resonance imaging follow-up was conducted depending on the disease’s condition. The Visual Analog Scale and the PedsQL4.0 Chinese Version was utilized to assess the changes in pain severity, limb motion evaluation, and quality of life before and after treatment.</div></div><div><h3>Results</h3><div>The study included 22 cases, comprising four arteriovenous malformations, nine venous malformations, two diffuse microcystic lymphatic malformations, two cases of Klippel-Trenaunay syndrome, and five cases of fibro adipose vascular anomaly. All children presented with pain at the affected site (22 cases; 100%). The malformations were located in the limbs in 17 cases (77%), subcutaneous and intramuscular tissues of the buttocks in one case (4.5%), subcutaneous tissue of the abdominal wall in one case (4.5%), and retroperitoneal in three cases (14%). All 22 patients (100%) experienced pain. Additionally, 20 cases (91%) exhibited swelling at the affected site or developed swelling after physical activity. Limb hypertrophy was observed in five cases (23%), whereas another five cases (23%) showed signs of limb atrophy. Joint mobility restrictions were present in four cases (18%). Among these 22 patients, 17 cases (77.3%) experienced complete resolution of pain and local lesion appearance changes, whereas four cases (18.2%) reported pain relief. However, in one case (4.5%) of Klippel-Trenaunay syndrome, postoperative improvement was observed at the treatment site, but a new centripetal malformation developed within the treated region. This patient subsequently underwent surgical intervention, resulting in an improvement in clinical symptoms. The pre-treatment malformation volume was 209.85 ± 343.17 cm³, which reduced to 32.95 ± 66.04 cm³ 1 year after ablation. The volume reduction was statistically significant (t = 2.374; <em>P</em> = .026; <em>P</em> &lt; .05), with an average volume reduction rate of 85.51%. No major complications were found, such as nerve damage or skin burns.</div></div><div><h3>Conclusions</h3><div>Ultrasound-guided microwave ablation is a relatively safe and effective technique for treating pediatric vascular malformations. Further multicenter studies are recommended to validate these findings.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102240"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of family presence in the operating room during endovenous treatment: An EFFORT prospective observational study","authors":"Kilsoo Yie MD,&nbsp;A-Rom Shin RA,&nbsp;Eun-Hee Jeong RA,&nbsp;Bo-Mi Kim RA,&nbsp;Eun-Jung Hwang RA","doi":"10.1016/j.jvsv.2025.102237","DOIUrl":"10.1016/j.jvsv.2025.102237","url":null,"abstract":"<div><h3>Background</h3><div>Varicose vein treatments are increasingly using ambulatory endovenous procedures under local anesthesia. Despite their safety and feasibility, these procedures may induce significant psychological distress, a concern not currently addressed by exist guidelines. This study investigates the necessity for family presence (FP) during endovenous procedures and its effects on the disease treatment process, hypothesizing that FP can provide emotional support and enhance patient trust in medical staff.</div></div><div><h3>Methods</h3><div>This single-center, prospective observational study, conducted from September 2022 to March 2024, enrolled 175 patients scheduled for outpatient endovenous treatments. Participants were divided based on their preference for FP during the surgery into FP (n = 61 [34.9%]) and no FP (NFP) (n = 114 [65.1%]) groups. The primary outcome was the influence of preoperative anxiety on the preference for FP, with secondary outcomes focusing on its impact on perioperative pain and postoperative satisfaction. Data collection followed the STROBE guidelines for observational studies, with preoperative anxiety assessed using a modified Amsterdam Preoperative Anxiety and Information Scale (mAPAIS).</div></div><div><h3>Results</h3><div>There were no significant demographic or clinical differences between the FP and NFP groups. In the NFP group, common reasons for declining FP included concerns about displaying anxiety (36%) and a perceived lack of necessity (29.8%). The FP group reported significantly higher mAPAIS scores (5.2±1.7 vs 4.4±1.5; <em>P</em> = .003) and a stronger preference for FP (3.4±1.1 vs 2.1±0.8; <em>P</em> = .001). Logistic regression analysis identified higher preoperative anxiety as a significant predictor of opting for FP (odds ratio, 1.41; 95% confidence interval, 1.07-1.88; <em>P</em> = .015). Most FP patients (78.7%) and guardians (85.2%) reported reduced anxiety, enhanced emotional support, and greater trust in the medical team. However, FP did not affect perioperative pain (<em>P</em> = .52) or postoperative 3-month satisfaction scores (<em>P</em> = .42). Adverse events led to FP discontinuation in two cases (3.3%) (one owing to nausea and one owing to syncope in the family members).</div></div><div><h3>Conclusions</h3><div>FP during endovenous procedures plays a crucial role in reducing preoperative anxiety and enhancing patient comfort. These findings suggest the potential for integrating FP into clinical guidelines for minimally invasive procedures, promoting a more patient-centered approach in surgical care. Future studies should investigate the conditions under which FP is most beneficial, taking into account both patient preferences and procedural specifics.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102237"},"PeriodicalIF":2.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative early outcomes following primary radiofrequency ablation and polidocanol microfoam ablation of symptomatic, incompetent small saphenous veins","authors":"Mokhshan Ramachandran MD,&nbsp;Peter F. Lawrence MD,&nbsp;Steven M. Farley MD,&nbsp;David A. Rigberg MD,&nbsp;Johnathon Rollo MD,&nbsp;Vincent L. Rowe MD,&nbsp;Juan Carlos Jimenez MD, MBA","doi":"10.1016/j.jvsv.2025.102234","DOIUrl":"10.1016/j.jvsv.2025.102234","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Radiofrequency ablation (RFA) of symptomatic, incompetent small saphenous veins (SSVs) is supported by clinical practice guidelines, but polidocanol microfoam ablation (MFA) is not addressed in these guidelines owing to the absence of high-quality clinical data. However, some anatomical variations and clinical scenarios in patients with SSV reflux may be associated with equivalent or superior results when MFA is used compared with RFA. This study aims to compare early outcomes after the treatment of SSV incompetence in patients with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) 2 class to 6 disease using either RFA or MFA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective review of a prospectively maintained database was conducted among patients who underwent treatment of incompetent SSVs with either RFA or MFA. Limbs that underwent concomitant phlebectomy were included. All patients underwent postoperative duplex ultrasound at 48 to 72 hours and at least one follow-up visit by a vascular surgery provider. Primary outcomes were immediate SSV closure and ablation-related thrombus extension. Secondary outcomes analyzed included demographic data, CEAP clinical class, Venous Clinical Severity Score (VCSS), deep venous thrombosis, and adverse events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Between March 2018 and July 2024, 182 SSVs treated for symptomatic reflux with either RFA (n = 120) or MFA (n = 62) were identified. Age, gender, body mass index, reflux times, and SSV diameters were similar between both groups. The mean preoperative VCSSs were 9.4 ± 3.0 and 10.8 ± 3.7 in the RFA and MFA groups, respectively (&lt;em&gt;P&lt;/em&gt; = .05). More venous ulcers were present at the time of MFA (n = 16 [26%]) than RFA (n = 14 [12%]) (&lt;em&gt;P&lt;/em&gt; = .015). Median follow-up was 164.5 days in the RFA cohort and 156 days after MFA. Symptomatic improvement after RFA and MFA was 91% and 88%, respectively. The mean postoperative VCSS decreased from 9.4 to 7.3 in the RFA group (&lt;em&gt;P&lt;/em&gt; &lt; .001) and from 10.9 to 9.2 after MFA (&lt;em&gt;P&lt;/em&gt; &lt; .001). Immediate vein closure was achieved in 98% of limbs in both groups; two late recanalizations occurred after MFA, but none after RFA. The number of ulcers healed at last follow-up was greater after MFA (n = 13 [81%] vs n = 10 [71%]; &lt;em&gt;P&lt;/em&gt; = .02). The incidence of ablation-related thrombus extension was 4.8% (n = 3) after MFA and 1.7% (n = 2) after RFA (&lt;em&gt;P&lt;/em&gt; = .52). One gastrocnemius deep venous thrombosis occurred in the MFA group. No pulmonary emboli or central nervous complications occurred. All adverse thrombotic events were asymptomatic and resolved with short-term anticoagulation. Superficial phlebitis was higher after MFA (n = 11 [17.7%] vs n = 5 [4.2%]; &lt;em&gt;P&lt;/em&gt; = .002) One postoperative sural neuralgia occurred after RFA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;RFA and MFA are both safe and effective treatments for patients with symptomatic, incompetent SSVs. Both resulted i","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102234"},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A venous hemodynamic model and measurement of venous reflux in the lower limb during walking—Proof of concept","authors":"Oscar Maleti MD ,&nbsp;Marzia Lugli MD ,&nbsp;Giorgio Bergamo BSc ,&nbsp;Andrew Nicolaides MS","doi":"10.1016/j.jvsv.2025.102236","DOIUrl":"10.1016/j.jvsv.2025.102236","url":null,"abstract":"<div><h3>Objective</h3><div>Air plethysmography (APG) is an established plethysmographic method of measuring leg volume changes in absolute units (mL or mL/s) during tiptoeing. However, tiptoe movements use different muscles from walking and the question of how physiological APG measurements during tiptoeing are has never been answered. The recent development of a commercially available wireless APG enables one to obtain measurements during walking. The aim of our pilot study was to (a) validate a venous hemodynamic model of blood volume changes in the leg during walking and (b) determine the magnitude of reflux per step in patients with venous reflux using this model.</div></div><div><h3>Methods</h3><div>A total of 20 limbs were included in this study. Ten patients with 10 limbs that had axial reflux in the deep veins on duplex scanning without any outflow obstruction or residual thrombosis on venography were selected. Standard measurements were initially made using tiptoeing as the form of exercise. Venous volume measurements made when walking was the exercise were volume on standing (V₀) in milliliters, volume at steady state when walking (V_ss) in milliliters, residual volume fraction during steady state as a percentage, ejection fraction (EF) as a percentage and inflow into the leg (I), which included reflux and arterial inflow in mL/step.</div></div><div><h3>Results</h3><div>There was an exponential reduction in volume during the first 7 to 9 steps, indicating a constant EF and supported the assumptions for the volume hemodynamic model. V₀, EF, and I were higher in limbs with reflux compared with limbs without reflux by 67% (<em>P</em> &lt; .007), 44% (<em>P</em> = .009), and 156% (<em>P</em> &lt; .001) respectively.</div></div><div><h3>Conclusions</h3><div>The results of this pilot study indicate that the model and method used provide a practical noninvasive method of measuring reflux during walking. The increase in V₀ and EF indicates a compensatory mechanism. This is the first time such a measurement has been possible because of the availability of wireless air plethysmography. It offers an opportunity for further studies to answer questions such as what the effect of iliac stenting or valvuloplasty are on reflux during walking.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102236"},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic exogenous progestins with or without estrogens are associated with decreased rates of venous procedures for varicose veins","authors":"Paarth Jain BS ,&nbsp;Adam Ostrovsky BS ,&nbsp;Paul DiMuzio MD ,&nbsp;Luis Eraso MD ,&nbsp;Michael Nooromid MD ,&nbsp;Dawn Salvatore MD ,&nbsp;Babak Abai MD","doi":"10.1016/j.jvsv.2025.102235","DOIUrl":"10.1016/j.jvsv.2025.102235","url":null,"abstract":"<div><h3>Objectives</h3><div>Risk factors for varicose veins (VVs) such as female sex, pregnancy, and obesity are high estrogen states, yet the role of systemic progestins with or without estrogens (SPEs) in VV management is not well characterized. This study investigates how SPE use affects rates of venous procedures for patients with VV.</div></div><div><h3>Methods</h3><div>The TriNetX database was queried for subjects with <em>International Classification of Diseases</em>, 10th edition, diagnoses of asymptomatic VV, chronic venous insufficiency, and complicated VV (inflammation or ulceration). Patients were divided into a control cohort with no subsequent SPE use, a progestin-only cohort, and a combined estrogen-progestin (CEP) cohort. Further stratification by VV symptomology and premenopausal status (age &lt;40 years) was also performed. Cohorts were one:one propensity matched on known and theorized risk factors for VV including age, race, prior pregnancy, and body mass index. The outcomes of interest were deep vein thrombosis, pregnancy, stab phlebectomy, endovenous ablation, and sclerotherapy.</div></div><div><h3>Results</h3><div>Database query yielded 674,838 controls, 7597 CEP patients, and 13,758 progestin-only patients before matching. After propensity matching, compared with controls, the CEP cohort received fewer stab phlebectomies (relative risk [RR], 0.52; 95% confidence interval [CI], 0.42-0.64; <em>P</em> &lt; .001), endovenous ablations (RR, 0.50; 95% CI, 0.43-0.59; <em>P</em> &lt; .001) or any venous interventions (RR, 0.68; 95% CI, 0.61-0.76; <em>P</em> &lt; .001), with no difference in sclerotherapy (<em>P</em> = .12). Similarly, the progestin-only cohort was less likely to receive stab phlebectomy (RR, 0.37; 95% CI, 0.31-0.43; <em>P</em> &lt; .001), endovenous ablation (RR, 0.35; 95% CI, 0.31-0.40; <em>P</em> &lt; .001), sclerotherapy (RR, 0.65; 95% CI, 0.56-0.75; <em>P</em> &lt; .001), and any venous procedure (RR, 0.57; 95% CI, 0.52-0.62; <em>P</em> &lt; .001). Compared with the progestin-only cohort, the CEP cohort had higher rates of sclerotherapy (RR, 1.38; 95% CI, 1.12-1.72; <em>P</em> = .003) and overall venous procedures (RR, 1.16; 95% CI, 1.00-1.34; <em>P</em> = .048). When possible, analysis stratified by symptomatic status and menopausal status revealed similar findings for subcohorts. Finally, the CEP cohort had lower risk of pregnancy than controls during the first 1200 days of observation, but subsequently had greater risk of pregnancy (RR, 1.38; 95% CI, 1.21-1.57; <em>P</em> &lt; .001). Kaplan-Meier analysis showed that the rates of venous intervention were lower throughout the observation period.</div></div><div><h3>Conclusions</h3><div>This large, population-based cohort study demonstrated that, despite variable risk of deep vein thrombosis and pregnancy for estrogen-progestin and progestin-only treatment cohorts, both SPE formulations were associated with significantly fewer venous procedures for VVs than c","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102235"},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-intensity-focused ultrasound treatment for the chronic venous disease based on the Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire (CHIVA) strategy","authors":"Luis Miguel Izquierdo Lamoca MD, PhD, FEBVS ,&nbsp;Teresa Reyero Postigo MD, RVT ,&nbsp;Sonia Morán Escalona MD ,&nbsp;Juan Francisco Giráldez Arranz MD ,&nbsp;Ana Aguinaco Acosta RN","doi":"10.1016/j.jvsv.2025.102233","DOIUrl":"10.1016/j.jvsv.2025.102233","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic venous disease management has significantly advanced with minimally invasive techniques like endovenous thermal ablation. High-intensity focused ultrasound (HIFU) is a noninvasive alternative thermal ablation method enabling targeted vein closure without percutaneous access. This study evaluates the efficacy of HIFU treatment, combined with the Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) strategy, in occluding leak points in patients with superficial venous reflux.</div></div><div><h3>Methods</h3><div>This retrospective study included patients treated for chronic venous disease using the SONOVEIN device from March 2020 to February 2024. Inclusion criteria were symptomatic patients (CEAP ≥C2) with ultrasound-confirmed truncal reflux. Patients under 18 years, with &lt;12 months life expectancy, or isolated venous flow obstruction were excluded. Treatments followed CHIVA principles, targeting leak points and proximal vein segments for occlusion. Primary endpoints were leak point occlusion rates and procedural safety. In this study, primary efficacy was defined as vein closure with one treatment, whereas secondary efficacy was defined as the need for more.</div></div><div><h3>Results</h3><div>A total of 204 limbs in 183 patients (131 females, 52 males; mean age, 55.2 years) underwent HIFU treatment. Primary leak point occlusion rate at 1 week, and 1, 6, 12, and 24 months were 85.1 %, 91.8%, 93.7%, 94.3%, and 95.5%, respectively. Secondary closure rates at 1 week, and 1, 6, 12, and 24 months were 89.6 %, 95.4%, 95.0%, 95.4%, and 95.7%, respectively. Overall primary and secondary cumulative closure rates at 24 months were 88.1% (95% confidence interval, 77.7%-98.4%), and 92.1% (95% confidence interval, 83.3%-100%), respectively. No major complications were observed.</div></div><div><h3>Conclusions</h3><div>HIFU achieves high leak point occlusion rates when applied under CHIVA principles, supporting its role as an effective and safe noninvasive alternative for chronic venous disease treatment. The technique minimizes risks associated with thermal ablation, such as skin burns and nerve damage, while addressing limitations of conventional methods. These results highlight the potential of HIFU as a disruptive technology in venous disease management. Further studies should assess its long-term efficacy and safety.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102233"},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A real-world study of sirolimus in the treatment of pediatric head and neck lymphatic malformations","authors":"Jialu Wang MD ,&nbsp;Yiran Meng MMSc ,&nbsp;Xuexi Zhang MD ,&nbsp;Yanzhen Li MD ,&nbsp;Nian Sun MD ,&nbsp;Qiaoyin Liu MD ,&nbsp;Yun Peng MD ,&nbsp;Xiaoling Cheng MSPharmSci ,&nbsp;Yuanhu Liu MMSc ,&nbsp;Zhiyong Liu MD ,&nbsp;Yuwei Liu MD ,&nbsp;Ge Zhang MD ,&nbsp;Xin Ni MD ,&nbsp;Shengcai Wang MD","doi":"10.1016/j.jvsv.2025.102230","DOIUrl":"10.1016/j.jvsv.2025.102230","url":null,"abstract":"<div><h3>Objective</h3><div>Sirolimus has shown promise in treating lymphatic malformations (LMs); however, previous studies were all single-arm clinical trials. Prior studies have reported that some LMs lesions can spontaneously reduce, which poses a potential confounding factor in evaluating therapeutic outcomes. Our study aimed to assess the effectiveness and safety of oral sirolimus objectively for LMs in the head and neck by comparing the outcomes in a control group.</div></div><div><h3>Methods</h3><div>This real-world study involved 57 children with LMs from 2020 to 2023 at Beijing Children's Hospital. The patients were divided into nonintervention and oral sirolimus groups. The primary outcome was lesion volume change on magnetic resonance imaging, and the secondary outcome was improvement in clinical symptoms. Safety was assessed based on adverse reactions (regular laboratory tests and patient follow-ups) and sirolimus blood concentrations in the oral sirolimus group.</div></div><div><h3>Results</h3><div>Twenty-one children were enrolled in the nonintervention group (14 male and 7 female), with a median age of 33 months (interquartile range [IQR], 9-53.5 months); 36 children were enrolled in the oral sirolimus group (15 male and 21 female), with a median age of 24 months (IQR, 7.5-51.25 months). The median volume reduction ratio in the nonintervention group was 0.08 (IQR, 0.30-0.40), and eight cases (38.1%) had an effective response. The median volume reduction ratio in the oral sirolimus group was 0.67 (IQR, 0.40-0.92), and 33 cases (91.7%) had an effective response. Clinical symptoms improved in 9 children (42.9%) in the nonintervention group and 35 (97.2%) in the oral sirolimus group. The effective rate and volume changes differed statistically significantly (<em>P</em> &lt; .001). The most common adverse reaction in the oral sirolimus group was an increase in myocardial enzyme levels (n = 23 [63.9%]), followed by oral ulcers (n = 16 [44.4%]). The overall blood concentration of sirolimus was low during the drug administration in the oral sirolimus group, among which 10 children (27.8%) had a mean blood concentration of &lt;5 ng/mL.</div></div><div><h3>Conclusions</h3><div>Sirolimus significantly decreased lesion volume and improved clinical symptoms in most patients with LMs, especially those with macrocystic components. Conservative observations were only helpful in some patients, with relatively modest volume changes.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102230"},"PeriodicalIF":2.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforation from an inferior vena cava filter with six legs","authors":"Hua Yi Zhang MD,&nbsp;Dong Zhe Chai MD,&nbsp;Xin Wei Zhou MD","doi":"10.1016/j.jvsv.2025.102229","DOIUrl":"10.1016/j.jvsv.2025.102229","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102229"},"PeriodicalIF":2.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of venoactive compounds in post-thrombotic syndrome: A systematic review","authors":"Monika L. Gloviczki MD, PhD, DFAVF ,&nbsp;Julianne Stoughton MD, FACS, DFAVF, ABVLM ,&nbsp;Alessandra Puggioni MD, DFAVF, RPVI, RPhS ,&nbsp;Peter Gloviczki MD, PhD, FACS, DFSVS, DFAVF ,&nbsp;Joseph D. Raffetto MD, FACS, DFAVF","doi":"10.1016/j.jvsv.2025.102228","DOIUrl":"10.1016/j.jvsv.2025.102228","url":null,"abstract":"<div><h3>Background</h3><div>Post-thrombotic syndrome (PTS) has been highly prevalent; over 50% of the patients develop PTS after lower extremity acute deep vein thrombosis. Venoactive compounds (VACs) have been recommended for decades for patients with chronic venous insufficiency, including PTS. The objective of our study was to perform a systematic review to determine the quality of evidence on the utility of VACs for both prevention and treatment of PTS.</div></div><div><h3>Methods</h3><div>A systematic review was conducted to search the literature between January 1, 1980, and July 14, 2023, for venoactive drugs or medications, deep vein thrombosis, and PTS using PubMed, MEDLINE, life science journals, and the Cochrane Library. Only randomized controlled trials (RCTs) published in English were included in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the revised Cochrane risk-of-bias tool for RCTs were used.</div></div><div><h3>Results</h3><div>Ninety-four references were identified; 11 RCTs fulfilled the inclusion criteria. VACs administered were diosmin, hidrosmin/rutosides, micronized purified flavonoid fraction (MPFF), and sulodexide. The studies included a highly variable proportion of patients with PTS (8.6%-100%). Some older studies omitted details of the methodology. Two studies suggested benefit of diosmin and MPFF as adjunctive treatment to rivaroxaban in the prevention of PTS and showed low or unclear risk of bias. Evaluation of RCTs for the treatment of post-thrombotic chronic venous insufficiency found low or unclear risk of bias in 81.6% to 85.7%. All studies suggested that VACs were beneficial for PTS treatment; they improved venous symptoms, decreased edema, and helped heal venous ulcers.</div></div><div><h3>Conclusions</h3><div>This systematic review found that VACs had at least moderate quality of evidence in improving venous symptoms, decreasing edema, and accelerating venous ulcer healing. Two pilot RCTs of higher quality suggested the usefulness of diosmin and MPFF as adjunctive treatment to rivaroxaban therapy to reduce the incidence of PTS and improve deep vein recanalization. Because most RCTs were published over two decades ago, and several lacked the required precision in reporting, new high-quality, low-bias RCTs are needed to assess the role of specific VACs for both prevention and treatment of PTS.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 4","pages":"Article 102228"},"PeriodicalIF":2.8,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}